The following are summaries and other information related to Proposed Rules that the Department of Commerce and Insurance (DCI) has submitted to the Secretary of State for Publication in the Missouri Register. These rules will not go into effect until the public has had an opportunity to submit written comments, and to attend a public hearing if one is scheduled. Any person may offer comments on a Proposed Rule. The instructions for submitting comments, and the location and date of a hearing if one is scheduled, are located after the text of each rule. Please note that the official text of a Proposed Rule is the version that appears in the Missouri Register, not the draft copy on this site. Refer to the official copy if you wish to submit comments. We hope you find this site helpful and informative.

Proposed Rule Summary Fiscal Note(s) Link to Missouri Register
/Supporting Documents
Small Business
Impact Statement
Division

PROPOSED AMENDMENT

20 CSR 400-5.900
Suitability in Annuity Transactions
This proposed amendment implements the National Association of Insurance Commissioners (NAIC) Suitability in Annuity Transactions Model Regulation #275.

PUBLIC COST: This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate.

PRIVATE COST:  This proposed amendment will not cost private entities more than five hundred dollars ($500) in the aggregate.
February 15, 2024

This proposed amendment does not have an adverse impact on small businesses.

Insurance

PROPOSED AMENDMENT

20 CSR 400-13.100
Health Insurance Rates
This proposed amendment requires an actuarial value and cost-sharing factor spreadsheet be included in proposed rates and rate filings for health benefit plans.

PUBLIC COST: This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate.

PRIVATE COST:  This proposed amendment will not cost private entities more than five hundred dollars ($500) in the aggregate.
February 15, 2024

This proposed amendment does not have an adverse impact on small businesses.

Insurance

PROPOSED AMENDMENT

20 CSR 2270-1.021
Fees
This amendment increases renewal fees and cleans up language.

PUBLIC COST: This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate.

PRIVATE COST: This proposed amendment will cost private entities sixty-eight thousand, two hundred thirty-five dollars ($68,235) annually for the life of the rule.  It is anticipated that the costs will recur for the life of the rule, may vary with inflation and are expected to increase at the rate projected by the Legislative Oversight Committee.
February 15, 2024

This proposed amendment does have an adverse impact on small businesses.

Professional Registration – Veterinary

PROPOSED AMENDMENT

20 CSR 2200-6.030
Intravenous Infusion Treatment Administration by Qualified Practical Nurses; Supervision by a Registered Professional Nurse
This amendment will lift the IV push or bolus medication administration restriction on qualified practical nurses and list two (2) additional types of IV medication that qualified practical nurses will not administer.  The need for these changes was determined after the Board of Nursing reviewed a petition for rule review sent by a practicing Licensed Practical Nurse (LPN).  It has been determined that restricting qualified practical nurses from utilizing the IV push or bolus route of medication administration places an undue interruption and delay in patient care.

PUBLIC COST: This proposed rule will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate.

PRIVATE COST: This proposed amendment will not cost private entities more than five hundred dollars ($500) in the aggregate.
February 15, 2024

This proposed amendment does not have an adverse impact on small businesses.

Professional Registration – Nursing

EMERGENCY AMENDMENT

20 CSR 2200-6.030
Intravenous Infusion Treatment Administration by Qualified Practical Nurses; Supervision by a Registered Professional Nurse
This amendment will lift the IV push or bolus medication administration restriction on qualified practical nurses and list two (2) additional types of IV medication that qualified practical nurses will not administer.  The need for these changes was determined after the Board of Nursing reviewed a petition for rule review sent by a practicing Licensed Practical Nurse (LPN).  It has been determined that restricting qualified practical nurses from utilizing the IV push or bolus route of medication administration places an undue interruption and delay in patient care.

PUBLIC COST:  This emergency amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the time the emergency is effective. 

PRIVATE COST:  This emergency amendment will not cost private entities more than five hundred dollars ($500) in the time the emergency is effective.
February 15, 2024

This proposed amendment does not have an adverse impact on small businesses.

Professional Registration – Nursing

PROPOSED AMENDMENT

20 CSR 2231-2.010
Designation of License Renewal Dates and Related Application and Renewal Information
This amendment adds a convenience fee.

PUBLIC COST: This proposed rule will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate.

PRIVATE COST:  This proposed rule will cost private entities three hundred forty-six thousand five hundred dollars ($346,500) annually, one million, nine hundred six thousand two hundred thirty-three dollars ($1,906,233) biennially beginning in FY25, and one million, six hundred thousand six hundred ninety dollars ($1,600,690) biennially beginning in FY26. It is anticipated that the costs will recur for the life of the rule, may vary with inflation, and are expected to increase at the rate projected by the Legislative Oversight Committee.
February 1, 2024

This proposed amendment does have an adverse impact on small businesses.

Professional Registration – Professional Registration

EMERGENCY AMENDMENT

20 CSR 2231-2.010
Designation of License Renewal Dates and Related Application and Renewal Information
This amendment adds a convenience fee.

PUBLIC COST: This emergency amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the time the emergency is effective.

PRIVATE COST: This emergency amendment will cost private entities seven hundred twenty-three thousand three hundred fifty-nine dollars ($723,359) in the time the emergency is effective.
February 1, 2024

This proposed amendment does have an adverse impact on small businesses.

Professional Registration – Professional Registration

PROPOSED AMENDMENT

20 CSR 2165-2.050
Continuing Education Requirements
This amendment updates the continuing education requirements.

PUBLIC COST: This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate.

PRIVATE COST: This proposed amendment will not cost private entities more than five hundred dollars ($500) in the aggregate.
February 1, 2024

This proposed amendment does have an adverse impact on small businesses.

Professional Registration – Hearing Instrument Specialists

PROPOSED AMENDMENT

20 CSR 2250-5.020
Application and License Fees
The amendment increases original issuance and renewal fees.

PUBLIC COST: This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate.

PRIVATE COST: This proposed amendment will cost private entities sixty thousand fifty dollars ($60,050) annually and one million, one hundred thirteen thousand eight hundred twenty-five dollars ($1,113,825) biennially for the life of the rule. It is anticipated that the costs will recur for the life of the rule, may vary with inflation and are expected to increase at the rate projected by the Legislative Oversight Committee.
January 16, 2024

This proposed amendment does have an adverse impact on small businesses.

Professional Registration – Real Estate Commission

PROPOSED AMENDMENT

20 CSR 2200-4.010
Fees
The board is amending the fees to include an Advanced Practice Registered Nurse (APRN) application and renewal fee, correct outdated information, and renumber as necessary pursuant to statutory and other regulatory changes that have occurred.

PUBLIC COST:  This proposed rule will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate. 

PRIVATE COST:  This proposed rule will cost private entities one hundred eighty thousand two hundred eighty-five dollars ($180,285) beginning in FY24 and biennially thereafter over the life of the rule. It is anticipated that the costs will recur for the life of the rule, may vary with inflation, and are expected to increase at the rate projected by the Legislative Oversight Committee.
January 2, 2024

This proposed rule does not have an adverse impact on small businesses.

Professional Registration – Nursing

PROPOSED AMENDMENT

20 CSR 2200-4.020
Requirements for Licensure
This amendment updates the rule to current standards.

PUBLIC COST: This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate.

PRIVATE COST: This proposed amendment will not cost private entities more than five hundred dollars ($500) in the aggregate.
January 2, 2024

This proposed rule does not have an adverse impact on small businesses.

Professional Registration – Nursing

PROPOSED AMENDMENT

20 CSR 2200-4.100
Advanced Practice Registered Nurse
This amendment changes the recognition to a license.

PUBLIC COST: This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate.

PRIVATE COST: This proposed amendment will not cost private entities more than five hundred dollars ($500) in the aggregate.
January 2, 2024

This proposed rule does not have an adverse impact on small businesses.

Professional Registration – Nursing

PROPOSED AMENDMENT

20 CSR 2263-1.035
Fees
This amendment reduces the renewal fee.

PUBLIC COST: This proposed amendment will cost state agencies or political subdivisions eighty thousand dollars ($80,000) beginning in FY24 and biennially thereafter.  It is anticipated that the costs will recur for the life of the rule, may vary with inflation and are expected to increase at the rate projected by the Legislative Oversight Committee.

PRIVATE COST: This proposed amendment will save private entities eighty thousand dollars ($80,000) beginning in FY24 and biennially thereafter for the life of the rule.
December 15, 2023

This proposed rule does not have an adverse impact on small businesses.

Professional Registration – Social Workers

PROPOSED AMENDMENT

20 CSR 2220-2.900
Class N:  Health Care Facility Automated Dispensing [and Storage] Systems
This amendment clarifies and updates supervision, technology, and operational requirements for Class N Health Care facility automated dispensing systems.

PUBLIC COST: This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate.

PRIVATE COST: The board estimates private fiscal costs of forty-five thousand dollars ($45,000) annually, recurring over the life of the rule as reflected in the accompanying fiscal note.
October 16, 2023

This proposed amendment does not have an adverse impact on small businesses.

Professional Registration – Pharmacy

PROPOSED AMENDMENT

20 CSR 2220-2.910
Class O: Automated Dispensing Systems (Ambulatory Care)
This rule establishes licensing standards and requirements for Class O: Automated Dispensing Systems (Ambulatory Care).

PUBLIC COST: This proposed rule will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate.

PRIVATE COST: The Board estimates private fiscal costs of one million one hundred ten thousand seven hundred twenty dollars ($1,110,720) annually, recurring over the life of the rule as reflected in the accompanying fiscal note.
October 16, 2023

This proposed rule does not have an adverse impact on small businesses.

Professional Registration – Pharmacy

PROPOSED AMENDMENT

20 CSR 2030-14.020
Definition of Baccalaureate Degree From Approved Curriculum as Used in Section 327.312.1(1), RSMo
This rule is being amended to come into compliance with a statutory amendment via HB 2149 which became effective on August 28, 2022 increasing the required number of Legal Principles of Surveying, Missouri Surveying Law, Legal Principles and Boundary Control, Legal Aspects of Surveying, United States Public Land Surveying System (UPLSS) from three (3) hours to six (6) hours effective January 1, 2024.

PUBLIC COST: This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate.

PRIVATE COST: This proposed amendment will not cost private entities more than five hundred dollars ($500) in the aggregate.
October 16, 2023

This proposed rule does not have an adverse impact on small businesses.

Professional Registration – Land Surveyors

PROPOSED AMENDMENT

20 CSR 2030-14.030
Definition of Twenty Semester Hours of Approved Surveying Course Work as Used in Section 327.312.1(2), RSMo
This rule is being amended to come into compliance with a statutory amendment via HB 2149 which became effective on August 28, 2022 increasing the required number of Legal Principles of Surveying, Missouri Surveying Law, Legal Principles and Boundary Control, Legal Aspects of Surveying, United States Public Land Surveying System (UPLSS) from 3 hours to 6 hours effective January 1, 2024.

PUBLIC COST: This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate.

PRIVATE COST: This proposed amendment will not cost private entities more than five hundred dollars ($500) in the aggregate.
October 16, 2023

This proposed rule does not have an adverse impact on small businesses.

Professional Registration – Land Surveyors

PROPOSED AMENDMENT

20 CSR 2030-14.040
Definition of [Twelve] Fifteen Semester Hours of Approved Surveying Course Work as Used in Section 327.312.1(3), RSMo
This rule is being amended to come into compliance with a statutory amendment via HB 2149 which became effective on August 28, 2022 increasing the required number of Legal Principles of Surveying, Missouri Surveying Law, Legal Principles and Boundary Control, Legal Aspects of Surveying, United States Public Land Surveying System (UPLSS) from three (3) hours to six (6) hours effective January 1, 2024.

PUBLIC COST: This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate.

PRIVATE COST: This proposed amendment will not cost private entities more than five hundred dollars ($500) in the aggregate.
October 16, 2023

This proposed rule does not have an adverse impact on small businesses.

Professional Registration – Land Surveyors

PROPOSED AMENDMENT

20 CSR 2245-1.010
General Organization
This rule is being amended to reflect the 2024 edition of the Uniform Standards of Professional Appraisal Practice.

PUBLIC COST: This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate.

PRIVATE COST: This proposed amendment will not cost private entities more than five hundred dollars ($500) in the aggregate.
October 2, 2023

This proposed amendment does not have an adverse impact on small businesses.

Professional Registration – Appraisers

PROPOSED AMENDMENT

20 CSR 2245-3.005
Trainee Real Estate Appraiser Registration
This rule is being amended to reflect the 2024 edition of the Uniform Standards of Professional Appraisal Practice.

PUBLIC COST: This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate.

PRIVATE COST: This proposed amendment will not cost private entities more than five hundred dollars ($500) in the aggregate.
October 2, 2023

This proposed amendment does not have an adverse impact on small businesses.

Professional Registration – Appraisers

PROPOSED AMENDMENT

20 CSR 2245-8.030
Instructor Approval
This rule is being amended to reflect the 2024 edition of the Uniform Standards of Professional Appraisal Practice and to update the name of a course.

PUBLIC COST: This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate.

PRIVATE COST: This proposed amendment will not cost private entities more than five hundred dollars ($500) in the aggregate.
October 2, 2023

This proposed amendment does not have an adverse impact on small businesses.

Professional Registration – Appraisers

PROPOSED AMENDMENT

20 CSR 2150-5.025
Administration of Vaccines [Per Protocol]
This proposed amendment implements 2023 legislative revisions to section 338.010, RSMo, and establishes pharmacist immunization procedures under revised section 338.010.1(4), RSMo.

PUBLIC COST:  This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate. 

PRIVATE COST:  This proposed amendment will not cost private entities more than five hundred dollars ($500) in the aggregate.
September 15, 2023

This proposed amendment does not have an adverse impact on small businesses.

Professional Registration – Healing Arts

EMERGENCY AMENDMENT

20 CSR 2150-5.025
Administration of Vaccines [Per Protocol]
This emergency amendment implements 2023 legislative revisions to section 338.010, RSMo, and establishes pharmacist immunization procedures under revised section 338.010.1(4), RSMo.

PUBLIC COST:  This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the time the emergency is effective. 

PRIVATE COST:  This proposed amendment will not cost private entities more than five hundred dollars ($500) in the time the emergency is effective.
September 15, 2023

This proposed amendment does not have an adverse impact on small businesses.

Professional Registration – Healing Arts

PROPOSED AMENDMENT

20 CSR 2220-6.050
Administration of Vaccines [Per Protocol]
This proposed amendment implements 2023 legislative revisions to section 338.010, RSMo, and establishes pharmacist immunization procedures under revised section 338.010.1(4), RSMo.

PUBLIC COST:  This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the aggregate. 

PRIVATE COST:  This proposed amendment will not cost private entities more than five hundred dollars ($500) in the aggregate.
September 15, 2023

This proposed amendment does not have an adverse impact on small businesses.

Professional Registration – Pharmacy

EMERGENCY AMENDMENT

20 CSR 2220-6.050
Administration of Vaccines [Per Protocol]
This emergency amendment implements 2023 legislative revisions to section 338.010, RSMo, and establishes pharmacist immunization procedures under revised section 338.010.1(4), RSMo.

PUBLIC COST:  This proposed amendment will not cost state agencies or political subdivisions more than five hundred dollars ($500) in the time the emergency is effective. 

PRIVATE COST:  This proposed amendment will not cost private entities more than five hundred dollars ($500) in the time the emergency is effective.
September 15, 2023

This proposed amendment does not have an adverse impact on small businesses.

Professional Registration – Pharmacy

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